"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

May 24, 2019

Health officials in five states have warned people believed to be infected with measles and planning to travel that they could prevent them from getting on planes.

All eight individuals agreed to cancel their flights after learning the officials could ask the federal government to place them on a Do Not Board List managed by the Centers for Disease Control and Prevention, said Martin Cetron, director of the agency’s Division of Global Migration and Quarantine, which tracks disease outbreaks.

“The deterrent effect is huge,” he said.

CDC officials said the agency had been contacted about the individuals by health officials in New York, California, Illinois, Oklahoma and Washington.

The government’s travel ban authority often gets little discussion “because it is a politically charged and politically visible request,” said Lawrence Gostin, a professor of global health policy at Georgetown University.

Though less restrictive than isolation or quarantine, the public health measure “is seen as a government using its power over the people and the states, which is kind of toxic in America right now,” said Gostin. “There is nothing unethical or wrong about it. It’s just plain common sense that if you have an actively infectious individual, they should not get on an airplane.”

Health officials emphasize that vaccination is the best and most effective way to protect against measles, and that the majority of people with infectious, communicable diseases, like measles, listen to doctors’ advice not to travel.

Officials in Rockland County, N.Y. and New York City, the epicenter of measles outbreaks since last fall, say they have advised several infected individuals against traveling.

Earlier this spring, Rockland health officials, who have had 238 measles cases since last October, consulted with CDC about placing two infectious individuals on the list to prevent them from flying to Israel for the Passover holiday, a county spokesman said.

“It served as an effective deterrent,” said spokesman John Lyon. “They did not travel."

The second-largest Ebola outbreak ever continues to spread, and health officials now say it’s likely to reach the populous city of Goma. Once there, the risk of it spreading beyond the Democratic Republic of Congo to Rwanda, South Sudan, or Uganda increases.

Only a fraction of the health centres in Goma, the capital of North Kivu province, are prepared for a large-scale outbreak. The city, about 300 kilometres from the outbreak’s epicentre, sits at a major trade and migration crossroads and borders Rwanda, where Kigali’s international airport is only 160 kilometres away.

“I wouldn’t say (the spread to Goma) is inevitable, but it’s highly probable,” said Ray Arthur, director of the Global Disease Detection Operations Center at the US Centers for Disease Control and Prevention.

In the past three weeks, the number of areas with reported infections has increased from 21 to 22, with the newest affected area lying between Butembo – a city and trading hub near the epicentre – and Goma, said Arthur. Health zones where transmissions had previously stopped are now seeing new cases again.

If the disease reaches Goma, it will have far-reaching regional implications.

“There would be a whole set of political factors, a huge impact on the economy, and a huge social impact,” said Tariq Riebl, emergency response director for the International Rescue Committee, adding that there would be a domino effect regionally.

While cases in densely populated and well-connected Rwanda would drive up the risk of wider regional spread, South Sudan and Uganda both suffer from an acute lack of trained healthcare workers. The security situation in South Sudan, where sporadic clashes continue, would pose a major challenge, while none of the three neighbouring countries have enough equipped clinics to deal with a large-scale outbreak.

“The longer transmission goes on, the more likely it will get to one of those countries,” Arthur said.

If the WHO declares the outbreak a Public Health Emergency of International Concern, or PHEIC, that would likely lead to travel and trade restrictions – measures that could complicate humanitarian operations if border crossings are closed or suspended.

The WHO decided – for a second time – on 12 April not to declare the Ebola situation in Congo a PHEIC, but is under increasing pressure to do so from some public health experts. One concern if it does is that resulting border closures might increase the risk of transnational spread due to more people travelling illegally through porous borders.

With wider spread now looking likely, more staff from the US Centers for Disease Control and Prevention, Médecins Sans Frontières, UNICEF, and the World Health Organisation – as well as from other groups and NGOs – have been deployed to Goma.

There is currently no dedicated Ebola treatment centre in Goma, so isolating patients may be difficult. Hundreds of small clinics are scattered around the city across a large area, which would make it harder to monitor people if they became sick. There is also a shortage of trained nurses.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 21, 2019

The epidemiological situation of the Ebola Virus Disease dated May 20, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed.

• 292 suspected cases under investigation;

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka:

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Butembo and 1 in Musienene;

º 2 deaths at the CTE of Beni;

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa;

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019.

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

The incidence of measles in Finland has increased over the last year, says the National Institute for Health and Welfare (THL). While 11 cases of measles were diagnosed in the country in 2017, the number rose to 16 in 2018. All infections were contracted abroad.

According to THL, the increase in the number of infections reflects the spread of the disease elsewhere in the world, including Europe. "Over the past 12 months, tens of thousands of measles cases have been reported in European countries," Taneli Puumalainen, senior physician at THL, said.

In Finland, measles was introduced by those who had been abroad and then spread, mostly to family members. The biggest risk of a broader spread of measles last year was in Ostrobothnia, Western Finland, where an unvaccinated child contracted the disease in an area where the vaccination coverage was low.

Puumainen reminded travellers to check their vaccinations at least one month before a trip.

Drug resistance is a cause for concern

The prevalence of drug-resistant bacteria also increased in Finland in 2018 according to THL. In particular, the number of Enterococci cases tripled from 66 to 205. Resistant Enterobacteriaceae cases increased by more than half from 48 to 73.

Although the figures are growing, they are still small, according to THL. The situation in Finland, when assessed globally, is estimated to be very good thanks to an effective treatment system and hospital hygiene, explained Puumalainen.

"Drug-resistance to microbes should be a matter of concern. It is a big global problem that has a large impact on the price and effective use of antimicrobials in the future," said Puumalainen.

TBE vaccination recommended in summer

In 2018, the number of reported cases of tick-borne encephalitis (TBE) was 79, which was the same as the year before. While most infections were contracted in known risk areas, the incidence of the disease has been increasing for several years, according to THL.

TBE vaccination is recommended for those who will be outdoors in nature during summer for at least four weeks. Residents and travellers in risk areas are eligible for a vaccine as part of a national vaccine program. The list of risk areas is mainly includes clearly defined parts of archipelago regions in Finland, but this year the southwestern part of Lake Lohja in Uusimaa was also included by the national vaccine program. The most common tick-borne disease, borreliosis, however, does not have a vaccine.

On the whole, the situation regarding infectious diseases in Finland is stable, according to Puumalainen who pointed out there were no major epidemics or events threatening public health over the past year.

May 19, 2019

Dr. Michael Ryan, Executive Director of the Program at the World Health Organization (WHO), specializing in health emergency management, left the DRC this Saturday, May 18, after leading a work mission in Butembo. In particular, he described a serious problem of contamination of Ebola virus disease in areas where the epidemic was already under control.

"The problem now is reinfection of the areas. We stopped the transmission to Beni, we stopped the transmission to Mangina, to Mabalako, but we still have a bit of transmission," he said in an interview at ACTUALITE.CD

Dr. Michael Ryan also mentioned the difficulty of vaccinating all targeted individuals.

"Some patients have made trips to different villages. The problem right now is the movement of the population. It's hard to find everyone for vaccination," he added.

A driver from Bunia for the locality of Ariwara died Thursday, May 16, in a health center 21 km from the city of Niangara (Haut-Uele). He died after a short fever, says Acting Chief Medical Officer of the Niangara Health Zone Dr. Michel Sayo.

According to him, the deceased passed in transit through the cities of Mambasa and Isiro.

"He succumbed in a picture of fever and hemorrhage. What is worrying, he came from a red zone where this Ebola virus disease is rife. We suspected the Ebola virus," said Dr. Michel Sayo.

He stated that this case is of concern to the general public as well as health personnel, particularly in Niangara territory.

"It worries us. The virus is a disease for which it is enough to declare a case, and the epidemic spreads," he added.

However, he called the population to calm while waiting for the results of the laboratory.

"We took all the safety precautions. We ask people to wash their hands to avoid any possible contamination, " said Dr. Michel Sayo.

May 17, 2019

The Centre for Health Protection (CHP) of the Department of Health (DH) said today (May 17) that no additional case of measles infection had been recorded as at 4pm today and announced that the outbreak of measles infection at Hong Kong International Airport earlier has concluded.

A spokesman for the CHP said, "A total of 73 cases of measles infection were recorded so far this year, among them 29 cases were associated with the outbreak among airport workers. The incubation period of measles can last up to 21 days. Among the airport-associated cases, the date the patients last visited the airport during the communicable period was April 5. No new associated cases have been recorded in two incubation periods which ended today. We consider that the outbreak of measles infection at the airport has ended."

Regarding measles control measures implemented at the airport, a total of 23 persons had received measles vaccination at the airport vaccination station as at 6pm today, bringing the cumulative number of vaccinations given to 8 501 since March 22. The airport vaccination station will cease operation from tomorrow (May 18).

As for the blood test service, the DH earlier provided the measles serology test service to airport staff. A cumulative total of 777 blood samples have been collected. For the pilot service to provide measles serology testing for Filipino foreign domestic helpers working in Hong Kong, a total of 146 blood samples have been collected to date. Participants are notified individually of the serology results.

On October 1, 2018, the Rockland County (New York) Department of Health (RCDOH) alerted the New York State Department of Health (NYSDOH) of an unvaccinated teenaged traveler with diagnosed measles. During the next 17 days, RCDOH learned of an additional six unvaccinated travelers with measles.

On October 24, 2018, the Ocean County (New Jersey) Health Department alerted the New Jersey Department of Health (NJDOH) of a case of measles in an international traveler, with rash onset October 17. The unvaccinated travelers reported recent travel in Israel, where an outbreak of approximately 3,150 cases of measles is ongoing.

Investigations during October 1, 2018–April 30, 2019, identified 242 laboratory-confirmed and epidemiologically linked measles cases in New York, excluding New York City, and during October 17, 2018–November 30, 2018, identified 33 in New Jersey (Figure). The cases of measles were primarily in members of orthodox Jewish communities.

New York

The 242 cases in New York (excluding New York City) included 206 in Rockland County and 36 in nearby counties. Most patients resided in orthodox Jewish neighborhoods with low school immunization rates. The median patient age was 5 years (range = 0 days* to 63 years). The 2017–2018 New York State School Immunization Survey measles vaccination rate for students in prekindergarten through grade 12 was 98%; however, documented measles vaccination coverage in schools in the outbreak area was only 77%.

To prevent disease spread in schools, Rockland County and neighboring Orange County have excluded unvaccinated students from school for 21 days after a measles exposure. To further control spread after school exposures, in areas of Rockland County with measles cases, exclusions from school were expanded to include all nonimmune students at schools that had measles immunity rates of <95% as documented by 2 valid doses of measles-mumps-rubella vaccine (MMR) or serologic evidence of immunity.

To provide opportunities for vaccination, approximately 20 community vaccination events open to all ages were held in Rockland County and two in Orange County.

During October 1, 2018–April 30, 2019, Rockland County administered 19,661 MMR doses. NYSDOH, RCDOH, and private medical providers held nine informational events and distributed educational materials focused on measles prevention to 45,000 homes. A culturally appropriate and detailed vaccine education book was distributed to 15,000 Rockland County and 10,000 Orange County homes and medical providers.

Orthodox Jewish leaders were engaged in the outbreak response, with rabbinical leaders supporting vaccination efforts and community groups advocating for vaccination.

As of April 30, 2019, transmission was ongoing. This has been the largest measles outbreak in New York (outside New York City) since 1992 and, at 7 months, the longest documented outbreak in the United States since endemic measles was eliminated in 2000.

New Jersey

During October 17–November 30, 2018, 33 measles cases were confirmed in New Jersey, primarily in members of the orthodox Jewish community in Ocean County. The median patient age was 10 years (range = 6 months–59 years). In Ocean County, unvaccinated students were excluded from school for 21 days after a measles exposure. Some private schools excluded unvaccinated students for the duration of the New Jersey outbreak. NJDOH worked with local health officials and providers to facilitate delivery of >12,500 outbreak response doses of MMR vaccine to Ocean County medical providers. This outbreak was declared over on January 16, 2019.

A second outbreak occurred in the same community in March 2019, with no identified connection to the first outbreak.

In the New York outbreak, low community vaccination rates facilitated widespread measles transmission after introduction of imported measles in unvaccinated travelers.

Educational efforts regarding risks associated with undervaccination should be increased in communities with low vaccination rates. Health departments and clinicians should be aware of multiple ongoing measles outbreaks globally, and travelers should have evidence of measles immunity.

All U.S. communities should maintain ≥95% levels of age-appropriate vaccination coverage with 2 doses of MMR vaccine to ensure herd immunity (3).

May 15, 2019

A Sheraton Hotel in Richmond, B.C., and two associated restaurants have been shut down after 80 people became sick with norovirus over the weekend.

According to Vancouver Coastal Health (VCH), about 40 staff members and 40 guests have been affected by the illness. Cavu Kitchen Bar at the Hilton Vancouver Airport Hotel has also been closed in connection with the outbreak.

Currently, no one is allowed to stay at the Sheraton Vancouver Airport Hotel on Westminster Highway until the facility has been thoroughly cleaned.

"It's quite significant to shut down an entire hotel and especially at that size," said Claudia Kurzac, VCH's manager for environmental health.

"Given the numbers of people potentially exposed and that were ill, I think that was probably the best course of action to take."

A large conference of 500 people that began last Friday was being held at the Sheraton Hotel, according to Kurzac. VCH received a call during its off hours the next day about a problem at the hotel.

An inspector was sent out that afternoon.

Until the facility has been thoroughly cleaned, the hotel is now closed, along with two restaurants inside, a Starbucks and Harold's Bistro,

All rooms, public areas and food and beverage facilities must be sanitized before the hotel is safe to reopen.

"Norovirus is a very hardy virus that can survive on surfaces … so you need a higher level of disinfectant," said Kurzac.

In an email, Steve Veinot, the hotel manager, said that they are not able to trace the source of the outbreak.

2nd hotel affected

The Sheraton Hotel was not the only hotel that was affected.

On Saturday, a chef at the Cavu Kitchen Bar in the Hilton Vancouver Airport Hotel started to notice symptoms of norovirus, according to Kurzac. The hotel immediately closed down its food and beverage facilities, but the hotel remains open to guests.

The hotels are operated by the same company — Larco Hospitality — and staff members occasionally move between hotels to help out when a hotel is hosting a large function.

"It's unfortunate that so many people are ill, but I'm very impressed with the response from both hotels," Kurzac said.

● In April, three new PoE screening sites were established and operationalized - Kerwa in Kajo-Keji county, Birigo in Lainya county, and Lasu in Yei county - which are all in Western Equatoria State. Currently, IOM is operating in 13 active PoE EVD screening sites.

● DTM interviewed 6,246 households comprising of 24,755 individuals who arrived in South Sudan from abroad along South Sudan’s southern border.

● The majority are South Sudanese nationals (79.2%) followed by Ugandan (13.6%) and DRC nationals (4.4%). Most incoming movement was due to economic reasons (26.8%), health-care (13.6%) and return after voluntary travel (11.4%). 10.5% of individuals intended to stay at their destination for more than three months.

● During this reporting period, WASH completed construction of the medical waste management system including incinerators and waste pits at Panyume Primary Health Care Center (PHCC).

● WASH also established 2 stances of temporary latrines and 4 mobile handwashing stands, and provided IPC trainings to casual workers (screeners, cleaners, health hygiene promotors etc.) at all the three new PoE screening sites in Kerwa, Birigo and Lasu which were constructed in April.